Asking again, need help

sschwartz How to code E&M and small joint injections for multiple fingers

Posted:
Jul 10 2015, 11:23 AM Our Orthopedic who comes monthly to our clinic treated a new patient for multiple isses and I am unsure how to bill for them. He did a new patient E&M and then four small joint injections (20600) with 80mg of Depomedrol. One injection in left thumb, one in rt thumb, one in rt index finger and one in rt long finger. He want's me to bill the 20600 joint injection four times as well as the office level. would it be:
99204 w/mod 25 DX 724.5, 729.5 20600 w/mod F5,F6,F7 DX 727.03 (OTY 1) or QTY (3) ??? 20600 w/mod 59,FA (QTY 1) J1030(40mg) w/mod RT,LT DX 727.03 (QTY 2)
So afraid of overcharging or triggering a denial.

re: Asking again, need help

I would go with 99204/25, 20600FA qty1, 20600F5 qty1, 20600 F6 qty1, and 20600 F7 qty 1. The 59 is for unbundling or codes that should not be billed together so I wouldn't use it. No modifier for the J1040 just indicate the total number of ML's. Anyone agree?

re: Asking again, need help

Each payer has their own rules.. but according to Medicare the MUE is 6. So if the patient is there for something else other than injections you can code E/M code. As for 20600 your allowed 6 units per session per visit. This is a bilateral code. So you can use RT and LT and your informational modifiers.